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Having recently read an article in e-pod about nail bracing (orthonyxia) vs surgery I was wondering if anyone in Oz uses this bracing technique? I'm not a fan of doing nail surgery so this idea sounds appealing.

Arthur Hill did a Master's thesis on nail brace technique and compared it to nail surgery , I think . It should be availble through the library at Curtin University Perth, Western Australia. I am sure Arthur would be delighted to chat to you but unfortunately I do not have a copy of his email. I dare say someone will on the arena tho'.

We were taught to use the bracing technique at Glasgow a hundred years ago. It was always contraversial and ebbed and floed in popularity. Nail surgery offers a wider range of use but in the case of aseptic involution then bracing does hold its own. It does require a fare degree of skill and much motivation by the patient. This includes regular visits which can be costly as application takes time (particularly to the novice practitioner) There are other alternatives which include sulcus injectors, heat moulding nail tongs and chemical treatments such as urea.

Try the acrylic nail bracing system. It can be sealed in under nail polish or an acrylic nail. Minimal bulk and temporary relief to those unable to undergo nail surgery through choice or for other health reasons.

Not a permenant cure but better than bringing patient thro monthly to cut out that involuted nail.

I prefer the nail surgery option also but sometimes one has to consider an alternative.

One of my friends who came to me for foot advice and treatment asked me if one can stitch the nail to the nail bed in lieu of doing a procedure which would be "too invasive".I now can tell her that I read of a way to do this.

While the matrixectomy is a common procedure of choice for ingrown toenails, researchers from Germany believe an orthonyxia procedure, delivered via a new brace, may be more effective in treating these toenails.

In a study, which was recently published in the Journal of the American Podiatric Medical Association (JAPMA), the researchers found that patients who wore the brace experienced reduced pain and a quicker return to work than those who underwent surgery. However, a couple of DPMs are skeptical.

The recent study in JAPMA examined 41 patients with ingrown toenails. Twenty received the Emmert surgical procedure, which is a standard procedure in Germany. Twenty-one patients received orthonyxia via the VHO-Osthold Brace. Orthonyxia consists of implanting a small metal brace or plate onto the dorsum of the nail, according to the researchers.

Although both groups had pain at similar levels before treatment, study results showed pain resulting from treatment was “significantly lower” in patients who received a brace than in those who underwent the Emmert procedure. The study authors also pointed out that those wearing the brace could wear shoes without pain earlier than those who underwent the surgery.

Patients who received the brace did not take time off from work while 10 of the patients who underwent the surgical procedure needed an average of 14.7 days off from work postoperatively. Although basic treatment costs were higher for the brace group versus the Emmert surgery group, researchers note that the time off from work raised the total economic cost to $1,975.20 for the surgical group compared to $334.30 in the brace group. ....

I have done a little nail bracing as a student (with Arthur Hill) and remember the patients we used it on as being very happy with results as it prolonged relief from the involution. I can also remember it being quite fiddly getting it just right but we were students.

BACKGROUND Ingrown toe nail is a common foot problem; however, there are limited data concerning the treatment options for diabetic patients.

OBJECTIVE Because of the special attention given to avoidance of infection and ulceration of the foot in diabetics, we applied a new, simple nail device as a treatment option without any systemic treatment or surgical intervention.

METHODS AND MATERIALS We applied braces to 21 diabetic patients with ingrown toe nails. All had severe pain, erythema, and edema without suppuration or granulation tissue formation. Braces were applied until all the symptoms are cleared. We followed the patients for 2 years for the recurrence of symptoms and signs.

RESULTS All patients had immediate relief of symptoms once the brace was applied. After the dislocation of braces, 15 of 21 patients did not have any recurrences for 2 years. Six patients had recurrence of pain and ingrown nail and were willing to use the brace once more instead of having any operations.

CONCLUSION Nail brace application is a safe, simple, and inexpensive treatment option for diabetic patients with ingrown toe nails. Although there may be recurrences, patients are willing to use it for a second time as it is simple and pain free.

I was only joking about nail bracing with a patent today and suddenly this thread appears in my radar due to a post by newsbot. Man am I sticking bolts through my patients nails on Monday or what!

My old boss used to have a nail brace kit and also something that can only be described as a set of (de)curling tongues for nails- taking advantage of the thermoplastic properties of the nail they (allegedly) used to heat them up and straighten 'em. Lovin' it. :butcher:

BACKGROUND: The purpose of this study was to report our results treating symptomatic incurved toenail with a K-D(R) (S&C Biotech, Seoul, South Korea) device.

MATERIALS AND METHODS: Between October 2007 and March 2008, 19 patients (31 cases) underwent treatment of symptomatic incurved toenails with a K-D(R). The mean age of the patients involved was 38.8 +/- 12.4 years. The mean period of time at last followup was 13.3 +/- 4.9 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated at pretreatment and the last followup period. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured at pretreatment and last followup. The complication rate was also evaluated.

RESULTS: All ingrown toenails healed and the nail deformity was corrected within 3 weeks after the procedure. Among the 31 cases, only two cases of incurved toenails recurred on last followup (6% recurrence rate). The mean pretreatment AOFAS forefoot hallux score was 71.1 +/- 13.9 and improved to 100 by the last followup (p < 0.001). Every patient was very satisfied or satisfied with the results of treatment including the two cases of recurrence. The mean center to edge angle of the toenail improved from 51.1 +/- 9.5 degrees to 18.4 +/- 5.2 degrees by the last followup (p < 0.001). Minor paronychia, which were managed with local wound dressing and oral antibiotics, were identified in seven cases. No other complication associated with the K-D(R) were identified.

CONCLUSION: The management of an incurved toenail with the K-D(R) was an effective and safe treatment method for patients having symptomatic incurved toenail deformity

BACKGROUND: The purpose of this study was to report our results treating symptomatic incurved toenail with a K-D (S&C Biotech, Seoul, South Korea) device.

MATERIALS AND METHODS: Between October 2007 and March 2008, 19 patients (31 cases) underwent treatment of symptomatic incurved toenails with a K-D. The mean age of the patients involved was 38.8 +/- 12.4 years. The mean period of time at last followup was 13.3 +/- 4.9 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated at pretreatment and the last followup period. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured at pretreatment and last followup. The complication rate was also evaluated.

RESULTS: All ingrown toenails healed and the nail deformity was corrected within 3 weeks after the procedure. Among the 31 cases, only two cases of incurved toenails recurred on last followup (6% recurrence rate). The mean pretreatment AOFAS forefoot hallux score was 71.1 +/- 13.9 and improved to 100 by the last followup (p < 0.001). Every patient was very satisfied or satisfied with the results of treatment including the two cases of recurrence. The mean center to edge angle of the toenail improved from 51.1 +/- 9.5 degrees to 18.4 +/- 5.2 degrees by the last followup (p < 0.001). Minor paronychia, which were managed with local wound dressing and oral antibiotics, were identified in seven cases. No other complication associated with the K-D were identified.

CONCLUSION: The management of an incurved
toenail with the K-D was an effective and safe treatment method for patients having symptomatic incurved toenail deformity.

I read this article with interest. It looks like a great, relatively noninvasive way to deal with a pincer nail. I finally tracked down the company that will be supplying the US. They anticipate each brace to sell for $320. I don't see how any insurance will pay for it. Any ideas on coding? I plan to offer this option to at least one patient but don't expect doing many if it's coming out of the patients pocket. Any one else using this device?

Dear Colleagues,
I was impressed to see the device placed in the distal nail, and I imagine how it must be the shoes which you can enter as long a nail with the screw included.
In my thirty years of practice, I have used successfully with conservative techniques long nail in tile.
Obviously, the results are acceptable during treatment, but often relapse after leaving the deformation processing, and finally the patients are candidates for definitive treatment by removing the nail completely noninvasive technique (chemistry).
But to dismiss the conservative treatment as an alternative to surgery a horrible example, is unacceptable.
These treatments have been for years, developed in South America, where podiatrists can not perform surgery.
The reason they were forced to conservative treatment to raise the status of art, being simple implementation, to be adequately trained in basic training.
Those who do not enjoy this training, we look for good teachers to get you started.
If we opt for self-learning, we are doomed to failure, or at other times mediocre result.
Nelson C. Peiré, Uruguay, in 1981, he published his experiences with ortonixia metal.
Armando Bega Currently, Brazil is the best teacher of this technique.
His publications "Basic Podiatry" em Podiatry Feridas and healing "and" Treaty of Podiatry ", which describes this technique, no value to the privilege of witnessing live, ease and simplicity of this treatment in their hands.
SENAC Also, a public institution in Brazil training for podiatrists now offered us technical publications on various conservative of considerable interest, they teach their students.
Carlos Alberto Rodriguez, Argentina, developed in the 80's the "CLIP" or fiber molecular memory based on the ownership of certain plastics to return to its original shape.
Apply a plastic film to the affected nail, attached with superglue in a simple but special, getting a spectacular result.
Orthodontic Bracket, glued on the nail plate, which are base metal brace set, retaining rings, etc.. to change the curvature nail
Light-cured acrylic resins and composites, are prominent as assistants in this type of techniques.
Could you find my Post "CASE REPORT: Conservative treatment Onicocriptosis" in Podiatry-sand forum "Spanish".
A series that will continue to expand soon ...
As you see, there are multiple alternatives to surgical treatment, to be applied only to the failure of these.
I hope I was helpful.
Best regards:Jose Antonio Teatino

You cant use the nails out of a coil nailer to nail speed bracing or triple grips because the nail will shear off at the head under compression or tension, especially on speed brace when the roof gets loaded. Nails for roof bracing and so on you use connector nails or clouts, steel ones for speed brace and galvo ones for triple grips, cyclone straps etc.
Nails for sheet bracing depends on what thickness sheets you are given. What wind rating is it?..

Background: We sought to report the clinical results of a new conservative treatment modality that uses a shape memory alloy device in patients with ingrown toenail.

Methods: A retrospective review was performed on 41 patients with ingrown toenail treated with the K-D device (S&C Biotech, Seoul, South Korea) between April 2013 and July 2014. Recurrence rate, cosmetic results, pain during the treatment period, and patient satisfaction were the major outcome measures.

Results: Patients were followed for at least 6 months (mean ? SD, 8.6 ? 2.1 months; range, 6–12 months). Recurrence was seen in eight patients (19.5%). Mean time to recurrence was 6.2 months (range, 3–10 months). Thirty-one patients (75.6%) were satisfied with the treatment. Thirty-five patients (85.4%) rated the application and treatment period as painless, and the remaining six (14.6%) noted pain particularly during shoe wearing. Thirty-one patients (75.6%) rated the cosmetic results as “excellent,” four (9.8%) as “acceptable,” and six (14.6%) as “poor.” Satisfaction with the treatment, the cosmetic results, and pain were significantly worse in patients with recurrence (P = .0001 for all). All of the patients returned to their work immediately after application of the device. No complications occurred.

Conclusions: The K-D device is a safe and effective treatment method for ingrown toenail. Although the recurrence rate is higher than for surgical treatment methods, the K-D device is a practical and painless method that provides immediate return to work and daily activities and excellent or acceptable cosmesis in most patients.

Background: Ingrowing Nail is an ailment in the toe area. This problem is observed in 20% of the population, in all age groups, but most often occurs in teenagers and young adults. The process of ingrowing nail stimulates natural defence mechanisms of the body in the form of inflammation and severe pain.

Aims: The aim of this paper is to make the VHO-Osthold® Perfect buckle effective as an alternative to nail plate surgery and to determine the patient's comfort during this method of treatment. Patients/Methods A descriptive case study conducted in a 15-year-old patient who had ingrowing nails in the big toes of both feet.

Results: It has been shown that the VHO-Osthold® Perfect buckle therapy constitutes an effective method for ingrowing nails and one in a few conservative methods in orthonyxia, as an alternative to surgery.

Conclusions: The study and clinical experience confirm that the therapy of ingrowing nails with the VHO-Osthold® Perfect buckle is painless and non-invasive. This treatment can be safely and effectively carried out by a qualified podiatrist or cosmetologist in podological practice.